在意大利南部关于产后甲状腺炎的一项大型前瞻性研究中持久性甲状腺功能减退症的发生率较高

High Rate of Persistent Hypothyroidism in a Large-Scale Prospective Study of Postpartum Thyroiditis in Southern Italy

在意大利南部关于产后甲状腺炎的一项大型前瞻性研究中持久性甲状腺功能减退症的发生率较高海南医学院附属医院内分泌科王新军

Context: The incidence of postpartum thyroiditis (PPT) varies widely in the literature. Limited data exist concerning the hormonal status of women with PPT at the end of the first postpartum year.

背景：文献中产后甲状腺炎的发生率（PPT）差异很大。关于产后甲状腺炎妇女在产后第一年末的激素状态数据有限。

Objective: Our aim was to conduct a large prospective study of the incidence and clinical course of PPT.
目的：我们的目标是要进行一项关于产后甲状腺炎发生率和临床结局的大型前瞻性研究。
Design: A total of 4394 women were screened for thyroid function and thyroid autoantibodies at 6 and 12 months postpartum. Women were classified as being at high or low risk of having thyroid disease before any thyroid testing.

设计：总共4394例妇女在产后6个月和12个月筛查了甲状腺功能和甲状腺自​​身抗体。在进行任何甲状腺测试之前，妇女被分为甲状腺疾病高危或低危患者。

Setting: The study was conducted at two ambulatory clinics in southern Italy, an area of mild iodine deficiency.
设置：此项研究是在意大利南部两个门诊进行，这是一个轻度碘缺乏地区。

Patients: A total of 4394 pregnant women were studied.

患者：共有4394例妊娠妇女参加本研究。

Intervention: There was no intervention.

干预：没有进行干预。
Main Outcome Measures: We measured incidence, clinical presentation, and course of postpartum thyroiditis.

主要观察指标：我们观察了产后甲状腺炎的发病率、临床表现和发病过程。
Results: The incidence of postpartum thyroiditis was 3.9% (169 of 4384). Women classified as being at high risk for thyroid disease had a higher incidence of PPT than women classified as low risk (11.1 vs. 1.9%; odds ratio, 6.69; 95% confidence interval, 4.63, 9.68). Eighty-two percent of the 169 women with PPT had a hypothyroid phase during the first postpartum year. At the end of the first postpartum year, 54% of the 169 women had persistent hypothyroidism.

结果：产后甲状腺炎的发病率为3.9％（169/4384）。与被分为低危的妇女相比，被分为甲状腺疾病高危的妇女产后甲状腺炎发病率较高（11.1vs 1.9％；风险比为6.69；95％可信区间为4.63~9.68）。患产后甲状腺炎的169例妇女在产后第一年82%存在一个甲状腺功能减退期。在产后第一年末，这169例妇女中有54％存在持续性甲状腺功能减退。

Conclusions: One of every 25 women in southern Italy developed PPT. Women at high risk for thyroid disease have an increased rate of PPT. The high rate of permanent hypothyroidism at 1 yr should result in a reevaluation of the widely held belief that most women with PPT are euthyroid at the end of the first postpartum year.

结论：在意大利南部每25例妇女中就有1例发生产后甲状腺炎。具有甲状腺疾病高危的妇女其产后甲状腺炎的发生率增加。在产后1年持久性甲状腺功能减退的高发生率应以后再次评估。

J Clin Endocrinol Metab 2011 96: 652-657